How to save the world

 

 

In Cambodia, a child rides along with her mother, who is collecting trash to sell. Aid groups are focusing efforts on women, who allocate more money than men to their children and businesses AP/Ou eakiry

I t’s perfectly reasonable to doubt that humanitarian aid works – not least because it sometimes doesn’t. Helping people is harder than it looks, and humanitarians sometimes oversell how easy it is to make a difference. Then again, meet Mahabouba Muhammed, and we dare you to say it’s not worth trying.

Mahabouba is a shy, sweet Ethiopian who, at the age of 12, was sold by a neighbor to become the second wife of a 60-year-old man. The man beat and raped her, and the first wife, jealous of her husband’s lust for the interloper, beat her as well. Mahabouba became pregnant, but her pelvis wasn’t yet big enough to accommodate the baby, and there was no doctor to help with the delivery.

The baby became stuck and died, and Mahabouba sustained a horrific internal injury known as an obstetric fistula. This leaves women incontinent, constantly leaking waste, and smelly, and sometimes causes paralysis. The villagers believed that Mahabouba had been cursed by God, so they put her in a hut on the edge of the village.

“Then they took the door off, so that the hyenas would get me,” Mahabouba told us. When darkness descended, the hyenas approached. She couldn’t move her legs, but she held a stick in her hands and waved it frantically and shouted at the animals. All night long, the hyenas circled, and all night long, she fended them off.

When morning came, Mahabouba knew that her only hope would be to leave. She had heard of a Western missionary in a nearby village, so she began crawling in that direction, pulling herself along with her arms. A day later, the missionary opened his door and found her lying, half dead, at his front step.

The missionary took her to the Addis Ababa Fistula Hospital, where a US$300 operation restored her health. The doctors noticed that Mahabouba was smart and eager to help at the facility, so they taught her to read and write. Today she is on the medical staff, proudly walking about in a new nurse’s aid uniform and spending her days helping others.

Nobody would doubt that the $300 surgery was an extraordinarily good investment, even in a strict economic sense. Quite apart from giving a teenager her life back, it empowered her to get an education and a good job, and then to contribute to her country’s gross domestic product.

Recent research and experience have shown that aid often works better if channeled through women.

The question is how to find those extraordinarily good investments that make a difference while avoiding the bad ones. That’s something the world is getting better at, and recent research and experience have shown that aid often works better if channeled through women.

There’s a tendency to focus on all the terrible things that happen to women and girls in poor countries, from sexual trafficking to attacks where men throw acid on their faces. Those are all horrifying abuses. But an even more paramount lesson from the research is that women represent opportunity. Women aren’t the problem. They’re the solution.

We wrote Half the Sky: Turning Oppression into Opportunity for Women Worldwide to show how women can be a powerful force for fighting poverty.

A country can’t develop economically if it makes use of only half its population. One good predictor of an economy’s vitality is the proportion of the labor force composed of women. And frankly, women have a better record than men of spending money wisely. Across a variety of cultures, women are more likely to invest their money in educating their children or in starting small businesses. Men are more likely to allocate money to consumption – such as beer.

So what kinds of humanitarian aid work best? There’s no neat formula, but three areas have a particularly good record: girls’ education, microfinance and trade, and health and nutrition.

Educating girls provides more bang for the buck than educating boys, partly because of the impact on family planning. Educated girls have significantly fewer children. (That’s also true of educated boys, but not to the same degree.)

We’ve built a school for girls and boys in Cambodia through American Assistance for Cambodia. The group’s Girls Be Ambitious initiative helps keep girls in school. In a sense, this is bribery, but it works: If a girl has perfect attendance for a month, her family gets $10. Experiments in many countries show that this kind of incentive (cash payments or donations of food for children who go to school regularly) is one of the most cost-effective ways to boost attendance.

There’s some evidence that girls in high school drop out because they don’t have access to tampons or pads. The girls regularly miss school during their periods for fear of leaks, and then they fall further and further behind and eventually drop out. So several groups, including Camfed and Sustainable Health Enterprises, are providing cheap pads, and the initial results are promising.

A second area with a good record is microfinance and trade. In Half the Sky , we introduce a woman in Burundi – an African country that the World Bank counts as the poorest in the world – who parlayed a $2 loan from CARE into a business that makes banana beer and raises goats. She now supports her husband and is sending her children to school so they’ll have even more opportunities.

Through Kiva.org, you can make loans to borrowers in many parts of the world. We’ve visited the people in Afghanistan to whom we’ve lent money; they were startled and grateful when we walked into their shops.

The third area is the interwoven world of health and nutrition. For example, half of the children in many African countries don’t get enough vitamin A, and the lack of it is the leading cause of child blindness. As many as 500,000 children worldwide die or go blind each year because they don’t get enough vitamin A – and yet a capsule costs just two cents.

Health issues related to motherhood are especially troubling. A mother’s milk is a lifesaving substance, and formula mixed with unsafe water can be deadly. But far too often, women in poor countries believe they should hold off from nursing for the first 24 hours or supplement with formula or begin to wean early. Breast-feeding is cheap and effective – and, as a bonus, it functions as birth control.

As for maternal health, it’s simply a disgrace that the number of women who die in pregnancy and childbirth has remained steady for a quarter century – at more than half a million a year worldwide. We’ve seen hospitals in remote parts of Africa where women die for lack of $15 in medicines to treat hemorrhages or eclampsia. Moreover, after a woman dies, her children are at much greater risk of dying as well. Because maternal health is neglected, teenage girls like Mahabouba end up with fistulas.

We also need to bolster family planning – a woman won’t die in childbirth if she doesn’t get pregnant – and simultaneously push to improve midwifery and emergency obstetrics. The results would be fewer girls suffering fistulas and more women contributing to the economic development of their country.

Edna Adan Ismail has built a maternity hospital in Somaliland with her savings. A nurse-midwife by training, Ismail lives in an apartment in her hospital so she can be on call around the clock. She accepts no salary and devotes her pension to keeping the hospital going. She is heroic, but she could accomplish even more if a few people reached out to help her in their spare time (www.ednahospital.org).

The truth is that we’re gaining a much richer understanding of how to help people in other countries. Sure, it’s harder than it looks, and our efforts sometimes fail. But when you see Ismail’s hospital – or when you talk to Mahabouba, saved by a $300 operation – you know that it’s worth trying.